Introduction Notalgia paraesthetica is a condition associated with itching, and unassociated with a rash, that affects a segment of the body innervated by T2-T6 dorsal spinal nerves. It is believed to be a type of neuropathy. This single-handed practice reports one such case. It also describes a further eight cases of “neurogenic” pruritus which share similar characteristics to this condition but are in segments of the body innervated by cervical and lumbar spinal nerves. Traditional acupuncture has been described to help with skin conditions and this study was performed to see if it was successful in this type of pruritus.
Patients and Methods Over a nine-year period in a practice with an average list size of 2000 patients, nine patients aged 41 to 79 years presenting with segmental itching were identified. Other causes of pruritus were excluded by clinical examination, as well as by haematological and biochemical tests. Drug induced causes were also excluded. Duration of pruritus was six weeks (range 4 – 52 weeks). In eight patients itching was restricted to dermatomes innervated by the spinal nerves of the cervical spine, in two by the dorsal spine and in two by the lumbar spine. In three patients pruritus occurred in dermatomes innervated by two separate areas of the spine. Clinical examination revealed restricted cervical or lumbar movements in seven patients. Paravertebral tenderness and/or spasm of the paravertebral muscles was found in the areas of pruritus in seven patients. Skin changes associated with sympathetic nerve over-activity were noted in five patients. Six of the nine patients had x-ray evidence of degeneration of the spine.
Results All nine patients were treated by deep intramuscular stimulation of the paravertebral muscles in the dermatomes affected by pruritus. In total a median of three treatments (range 2 – 5) was required to resolve the pruritus. Recurrence of symptoms occurred in four patients within 8 to 12 months of their last treatment over a period of follow-up of 0.5 – 9 years (median one year). Repeat acupuncture treatment resolved the pruritus.
Discussion The term neurogenic pruritus describes and encompasses all conditions associated with segmental itching unassociated with a rash. The clinical signs of this condition are suggestive of an early neuropathy as a result of a degenerative condition of the spine. This is the first report of symptoms of such a condition being treated successfully by acupuncture.
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